España Agustín, Redondo Pedro
Departamento de Dermatología, Clínica Universitaria de Navarra, Facultad de Medicina, Spain.
Actas Dermosifiliogr. 2006 Mar;97(2):103-14. doi: 10.1016/s0001-7310(06)73360-9.
The systemic treatment of herpes zoster shortens the healing process, and prevents or alleviates pain and other acute or chronic complications, especially when it is administered in the first 72 hours after symptoms appear. This treatment is especially indicated in patients over the age of 50 and in those who, regardless of age, have head and neck involvement, especially in herpes zoster ophthalmicus. The drugs approved in Europe for the systemic treatment of herpes zoster are aciclovir, valaciclovir, famciclovir and brivudine. Brivudine shows greater effectiveness against the varicella-zoster virus than aciclovir and its derivatives, and can be given just once a day for seven days, compared to multiple doses of the latter. As opposed to the others, brivudine is a non-nephrotoxic drug that should not be administered to immunodepressed patients or to those being treated with 5-fluorouracil. The treatment of herpes zoster to reduce pain should be combined with analgesics and neuroactive agents (amitriptyline, gabapentin, etc). While corticosteroids are of dubious efficacy in the treatment of post-herpes neuralgia, the intensity and duration of the pain can be reduced with some topical treatments (capsaicin, lidocaine patches, etc). Finally, this review discusses treatment guidelines for special locations (cranial nerves) and different subpopulations (children, pregnant women, immunodepressed patients, etc).
带状疱疹的全身治疗可缩短愈合过程，并预防或减轻疼痛及其他急慢性并发症，尤其是在症状出现后的72小时内进行治疗时。这种治疗尤其适用于50岁以上的患者以及那些无论年龄大小、有头颈部受累的患者，特别是眼部带状疱疹患者。在欧洲被批准用于带状疱疹全身治疗的药物有阿昔洛韦、伐昔洛韦、泛昔洛韦和溴夫定。溴夫定对水痘-带状疱疹病毒的疗效比阿昔洛韦及其衍生物更佳，且只需每日服用一次，连服七天，而后者需多次给药。与其他药物不同，溴夫定是一种非肾毒性药物，但不应给予免疫抑制患者或正在接受5-氟尿嘧啶治疗的患者。减轻带状疱疹疼痛的治疗应与镇痛药和神经活性药物（如阿米替林、加巴喷丁等）联合使用。虽然皮质类固醇在治疗带状疱疹后神经痛方面的疗效存疑，但一些局部治疗（辣椒素、利多卡因贴片等）可减轻疼痛的强度和持续时间。最后，本综述讨论了特殊部位（颅神经）和不同亚人群（儿童、孕妇、免疫抑制患者等）的治疗指南。
